Consider the Strong Beneficence Principle (SBP): Persons of affluent means ought to give to those who might fail basic human subsistence until the point at which they must give up something of comparable moral importance. This principle has been the subject of much recent discussion. In this paper, I argue that no coherent interpretation of SBP can be found. SBP faces an interpretive trilemma, each horn of which should be unacceptable to fans of SBP; SBP is either (...) (a) so strong as to be patently absurd; (b) implausible given its acceptance of a form of numbers skepticism; (c) drained of all its demanding force. In the conclusion, I show how the problems with SBP generalize to all similarly demanding principles of beneficence. (shrink)

Beneficence is one of the four principles that form the basis of the Australian National Statement. The aim of this paper is to explore the philosophical development of this principle and to clarify the role that beneficence plays in contemporary discussions about human research ethics. By examining the way that guidance documents, particularly the National Statement, treats beneficence we offer guidance to researchers and human research ethics committee members on the practical application of what can be (...) a conceptually difficult principle. (shrink)

Although written primarily for medical research, the Belmont principles have permeated clinical medicine as well. In fact, they are part of a broad cultural shift that has dramatically reworked the relationship between doctor and patient. In the early 1950s, medicine was about making the patient better and maintaining optimism when the patient could not get better. By the 1990s, medicine was about the treatment of specific physiological systems, as directed by the patient, but as limited by the society's concern for (...) justice. (shrink)

In the last ten years, there have been a number of attempts to refute Julian Savulescu's Principle of Procreative Beneficence; a principle which claims that parents have a moral obligation to have the best child that they can possibly have. So far, no arguments against this principle have succeeded at refuting it. This paper tries to explain the shortcomings of some of the more notable arguments against this principle. I attempt to break down the argument (...) for the principle and in doing so, I explain what is needed to properly refute it. This helps me show how and why the arguments of Rebecca Bennett, Sarah Stoller and others fail to refute the principle. Afterwards, I offer a new challenge to the principle. I attack what I understand to be a fundamental premise of the argument, a premise which has been overlooked in the literature written about this principle. I argue that there is no reason to suppose, as Savulescu does, that morality requires us to do what we have most reason to do. If we reject this premise, as I believe we have reason to do, the argument for Procreative Beneficence fails. (shrink)

The claim that we have a moral obligation, where a choice can be made, to bring to birth the 'best' child possible, has been highly controversial for a number of decades. More recently Savulescu has labelled this claim the Principle of Procreative Beneficence. It has been argued that this Principle is problematic in both its reasoning and its implications, most notably in that it places lower moral value on the disabled. Relentless criticism of this proposed moral obligation, (...) however, has been unable, thus far, to discredit this Principle convincingly and as a result its influence shows no sign of abating. I will argue that while criticisms of the implications and detail of the reasoning behind it are well founded, they are unlikely to produce an argument that will ultimately discredit the obligation that the Principle of Procreative Beneficence represents. I believe that what is needed finally and convincingly to reveal the fallacy of this Principle is a critique of its ultimate theoretical foundation, the notion of impersonal harm. In this paper I argue that while the notion of impersonal harm is intuitively very appealing, its plausibility is based entirely on this intuitive appeal and not on sound moral reasoning. I show that there is another plausible explanation for our intuitive response and I believe that this, in conjunction with the other theoretical criticisms that I and others have levelled at this Principle, shows that the Principle of Procreative Beneficence should be rejected. (shrink)

Molecular genetic engineering technologies such as CRISPR/Cas9 have made the accurate and safe genetic engineering of human embryos possible. Further advances in genomics have isolated genes that predict qualities and traits associated with intelligence. Given these advances, prospective parents could use these biotechnologies to genetically engineer future children for genes that enhance their intelligence. While Julian Savulescu’s Principle of Procreative Beneficence (PPB) argues for the moral obligation of prospective parents to use in-vitro fertilization and preimplantation genetic diagnosis to (...) make eugenic selections of embryos for intelligence, the PPB could imply obligations to genetically engineer selected embryos for intelligence as well. I argue that the PPB implies an additional moral obligation for prospective parents to genetically engineer the embryonic germline identity of selected embryos for genes that predict intelligence. Objections to my argument for the PPB’s extension are also discussed. (shrink)

My objective of this paper is to suggest and workout a more credible form of the Principle of Beneficence from the common essential elements of the three major ethical theories (Deontology, Utilitarianism and Virtue Ethics) that will try to overcome the over-demanding objection of Utilitarianism and the rigorism of Kant’s Deontology. After analyzing these three moral systems, I find that beneficence lies within the very essence of humanity. Human beings are superior to other creatures in the world (...) due to rationality and humanity. From the humanitarian ground, a common goodness lies within every human. Beneficence, as a moral principle, is derived from this inner humanity of every individual. Despite their initial differences, utilitarianism, deontology and virtue ethics recognize this fundamental humanitarian disposition of doing good for all as a part of being a morally better person. The principle of beneficence as I suggest, is different from its consequential utilitarian notion suggested by Mill. This version of beneficence is more credible as it does not impose excessive demands upon an individual to develop any maximum beneficial outcome following utilitarian calculation of beneficence over cost, and it also strives to overcome the rigorous duty-based theory of Kantian deontology by appealing to the fundamental virtue of humanity. Finally, the credibility of this form of beneficence comes from the underlying transcendental humanism which is the chief feature of Indian tradition. (shrink)

The Principle of Procreative Beneficence claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These (...) are strong claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition. (shrink)

Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or (...) is it a matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

Imagine a world where everyone is healthy, intelligent, long living and happy. Intuitively this seems wonderful albeit unrealistic. However, recent scienti c breakthroughs in genetic engineering, namely CRISPR/Cas bring the question into public discourse, how the genetic enhancement of humans should be evaluated morally. In 2001, when preimplantation genetic diagnosis (PGD) and in vitro fertilisation (IVF), enabled parents to select between multiple embryos, Julian Savulescu introduced the principle of procreative bene cence (PPB), stating that parents have the obligations to (...) choose the child that is expected to have the best life. In this paper I argue that accepting the PPB and the consequentialist principle (CP) that two acts with the same consequences are morally on par, commits one to accepting the parental obligation of genetically enhancing one's children. (shrink)

A background assumption in much contemporary political philosophy is that justice is the first virtue of social institutions, taking priority over other values such as beneficence. This assumption is typically treated as a methodological starting point, rather than as following from any particular moral or political theory. In this paper, I challenge this assumption. To frame my discussion, I argue, first, that justice doesn’t in principle override beneficence, and second, that justice doesn’t typically outweigh beneficence, since, (...) in institutional contexts, the stakes of beneficence are often extremely high. While there are various ways one might resist this argument, none challenge the core methodological point that political philosophy should abandon its preoccupation with justice and begin to pay considerably more attention to social beneficence—that is, to beneficence understood as a virtue of social institutions. Along the way, I also highlight areas where focusing on social beneficence would lead political philosophers in new and fruitful directions, and where normative ethicists focused on personal beneficence might scale up their thinking to the institutional case. GPI Working Paper No. 11-2022. (shrink)

The principle of procreative beneficence, first suggested by Julian Savulescu, argues that: If couples have decided to have a child, and selection is possible, then they have a significant moral reason to select the child, of the possible children they could have, whose life is expected, in light of the relevant available information, to go best or at least not worse than any of the others. While the validity of this moral principle has been widely contested, in (...) this paper we move away from these issues and grant, for the sake of argument, that PB is a valid moral principle, and that the justification for PB provided by Savulescu and co-authors is sound. We do this in order to explore the implications and consequences of accepting PB and show that even if we put aside questions about the validity and theoretical foundations of this principle, PB has many interesting, astonishing and highly problematic implications that have not been made explicit in the writing of Savulescu and others who support the notion of an obligation to bring to birth the best child possible :204, 2002). We suggest that these implications should be taken into account when considering both the soundness and strength of PB. (shrink)

This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from (...) political philosophy has at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such (...) harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

Recently, Julian Savulescu and Guy Kahane have defended the Principle of Procreative Beneficence (PB), according to which prospective parents ought to select children with the view that their future child has ‘the best chance of the best life’. I argue that the arguments Savulescu and Kahane adduce in favour of PB equally well support what I call the Principle of General Procreative Beneficence (GPB). GPB states that couples ought to select children in view of maximizing the (...) overall expected value in the world, not just the welfare of their future child. I further argue that Savulescu and Kahane's claim that PB has significantly more weight than competing moral principles, such as GPB, lacks justification. A possible argument for PB having significant weight builds on a principle of parental partiality towards one's own children. But this principle does not support PB; it supports a Principle of Sibling-Oriented Procreative Beneficence (SPB), according to which parents selecting a child should maximize the benefit of all their children. Indeed, PB itself will in some cases be self-effacing in favour of SPB. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such (...) harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

The Principle of Procreative Beneficence (PB) holds that when a couple plans to have a child, they have significant moral reason to select, of the possible children they could have, the child who is most likely to experience the greatest wellbeing – that is, the most advantaged child, the child with the best chance at the best life.1 PB captures the common sense intuitions of many about reproductive decisions. PB does not posit an absolute moral obligation – it (...) does not dictate what people must do. Instead it holds that there is a significant moral reason to select the best child, but one that must be weighed against other reasons.Recent research suggests that it may become possible to derive gametes (eggs and sperm) from human stem cells in vitro, a process which we will term in vitro gametogenesis (IVG). The ability to create large numbers of eggs or sperm through IVG greatly increases our capacity to select the best child possible. (shrink)

Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation – the notion of impersonal harm or non-person-affecting wrong – is indefensible. Therefore, there can be no obligations of the sort that the principle asserts. The positive thesis, on the other hand, attempts to plug an explanatory gap that arises once the principle has been rejected. (...) That is, it holds that the intuitions of those who adhere to the principle are not genuine moral intuitions, but instead simply give voice to mere (non-moral) preferences. This paper, while agreeing that Savulescu's principle does not express a genuine moral obligation, takes issue with both of Bennett's theses. It is suggested that the argument for the negative thesis is either weak or question-begging, while there is insufficient reason to suppose the positive thesis true. (shrink)

The target article by Laacke et al. focuses on the specific context of identifying people in social media with a high risk of depression by using artificial intelligence technologies. I...

Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation – the notion of impersonal harm or non‐person‐affecting wrong – is indefensible. Therefore, there can be no obligations of the sort that the principle asserts. The positive thesis, on the other hand, attempts to plug an explanatory gap that arises once the principle has been rejected. (...) That is, it holds that the intuitions of those who adhere to the principle are not genuine moral intuitions, but instead simply give voice to mere (non‐moral) preferences.This paper, while agreeing that Savulescu's principle does not express a genuine moral obligation, takes issue with both of Bennett's theses. It is suggested that the argument for the negative thesis is either weak or question‐begging, while there is insufficient reason to suppose the positive thesis true. (shrink)

This chapter aims to show that prospective parents are not bound in their reproductive decision making by a principle of procreative beneficence. That is, they have no obligation (as Julian Savulescu, the principle’s originator, famously thinks they have) to choose the possible child, from a range of possible children they might have, who is likely to lead the best life. I will summarise and clarify the content of previous papers of mine, in which I argue that since (...) the sorts of considerations that underlie the principle of procreative beneficence do not constitute reasons when viewed from a perspective that it is fitting and appropriate for a prospective parent to take up, there can be no requirement for prospective parents to be moved by those considerations. (shrink)

Julian Savulescu has given clear expression to a principle—that of “procreative beneficence”—which underlies the thought of many contemporary writers on bioethics. The principle of procreative beneficence holds that parents or single reproducers are at least prima facie obliged to select the child, out of a range of possible children they might have, who will be likely to lead the best life. My aim in this paper is to argue that prospective parents, just by dint of their (...) being prospective parents, are in fact not obliged to act on PPB. That is, there is something about their filling the role of prospective parents that exempts them from selecting the child with the best life. I urge that it is more realistic to view prospective parents as bound by a principle of acceptable outlook, which holds that they ought not to select children whose lives will contain an unacceptable amount of suffering. (shrink)

Resumen Tomando como punto de partida las condiciones del contexto socio político donde se originó el brote epidémico del virus SARS-CoV-2, los autores analizan la influencia que tuvo el principio de beneficencia como una de las razones éticas que condujeron al oftalmólogo Li Wenliang a alertar a través de la red social Weibo, sobre el surgimiento de un brote epidémico distinto, por su agresividad, al del SARS. Se asume que dicho principio puede comprenderse a partir de un enfoque donde se (...) conjugan referentes occidentales -la primera formulación del imperativo categórico kantiano y el legado hipocrático- y orientales -el principio del Ren o humanidad, derivado del pensamiento confuciano-. El artículo concluye señalando que en un mundo interrelacionado donde las prácticas médicas tienen fundamentos científicos universales, es posible tomar decisiones éticas médicas válidas para diferentes contextos culturales, siempre y cuando se continúe avanzando en el terreno de un diálogo inter-civilizatorio con perspectiva horizontal.This article analyzes the influence of the principle of beneficence as one of the ethical reasons that led ophthalmologist Li Wenliang to alert, using the Weibo plaform, about the emergence of an epidemic outbreak different from SARS. Accordingly, we discuss the socio-political context of the SARS-CoV-2 epidemic in China. We assume that the principle of beneficence might be understood from an approach combining Western references - the first formulation of the Kantian categorical imperative and the Hippocratic legacy - with Oriental ones - the Ren or humanity, derived from Confucian thought. We conclude that in an interrelated world, with medical practices having universal scientific foundations, it is possible to validate medical ethical decisions from different cultural contexts, as long as progress continues in the field of an inter-civilizational dialogue with a horizontal perspective. (shrink)

In chapter 3 of Wild Animal Ethics Johannsen argues for a collective obligation based on beneficence to intervene in nature in order to reduce the suffering of wild animals. In the same chapter he claims that the non-identity problem is merely a “theoretical puzzle” which doesn’t affect our reasons for intervention. In this paper I argue that the non-identity problem affects both the strength and the nature of our reasons to intervene. By intervening in nature on a large scale (...) we change which animals come into existence. In doing so, we enable harmful animals to inflict harms on other animals, and we put other animals in harm’s way. The harms that these animals will inflict and endure are foreseeable. Furthermore, since non-human animals aren’t moral agents, harmful animals cannot be morally responsible for their harmful actions. I argue therefore that by causing animals to exist, knowing that they will inflict and suffer harms, we become morally responsible for those harms. By engaging in identity-affecting actions then we take on secondary moral duties towards the animals we have thereby caused to exist, and these secondary moral duties may be extremely demanding, even more so than the initial costs of intervention. Finally, these duties are duties of justice rather than duties of beneficence, and as such are more stringent than purely beneficence-based moral reasons. Furthermore, this conclusion flows naturally from several plausible principles which Johannsen explicitly endorses. (shrink)

According to Peter Singer, virtually all of us would be forced by adequate reflection on our own convictions to embrace a radical conclusion about giving. The following principle, he says, is “surely undeniable” -- at least once we reflect on secure convictions concerning rescue, as in his famous case of the drowning toddler.

According to the Principle of Procreative Beneficence, reproducers should choose the child, of those available to them, expected to have the best life. Savulescu argues reproducers are therefore morally obligated to select for nondisease traits, such as intelligence. Carter and Gordon recently challenged this implication, arguing that Savulescu fails to establish that intelligence promotes well-being. This paper develops two responses. First, I argue that higher intelligence is likely to contribute to well-being on most plausible accounts. Second, I argue (...) that, even if it does not, one can only resist the conclusion that reproducers should select on the basis of intelligence if its expected net effect is neutral. If intelligence reduces expected well-being, then reproducers should select offspring of low intelligence. More likely, the effect of increased intelligence on expected well-being varies at different levels, which makes identifying an optimum for well-being more complex than hitherto appreciated. (shrink)

I argue for three principles of minimal beneficence, which constrain when and what at least we are obligated to do on behalf of someone. All three may be accepted by both the consequentialist Peter Singer and by his staunch opponents in material value-ethics, who are typically anti-consequentialists. Either side would philosophically benefit from accepting the principles. At the same time, the first principle is rarely applicable, the second only when the available relevant evidence is not too complex, and (...) the third only as a prompt to keep thinking seriously about how to practice beneficence. Even so, I derive some widely applicable, practical implications. (shrink)

Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia. For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: (...) beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’. This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community. The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths. (shrink)

My purpose in this paper is to show that current legal criteria for paternalistic involuntary psychiatric confinement of the mentally ill are both too narrow and too broad. I do this by first developing a principle of justified paternalistic interference with adults, which I take to be acceptably protective of individual liberty, but which does not require unnecessary sacrifices of individual welfare. After offering an analysis of current legal criteria for involuntary confinement, 1 argue that an acceptable theory of (...) paternalistic interference reveals that those criteria (1) exclude some cases where confinement would be morally permissible, and (2) allow paternalistic confinement of many whose detention is not morally justifiable. Keywords: paternalism, incompetence, involuntary civil confinement, liberty, beneficence, harm CiteULike Connotea Del.icio.us What's this? (shrink)

This article critically analyzes the principle of beneficence and the principle of nonmaleficence in clinical medical ethics. It resists some recent skepticism about the principle of nonmaleficence, and then seeks to explain its role in medicine. The article proposes that the two principles are informed by different accounts of what is in the patient’s best interests. The principle of beneficence is tied to the patient’s best overall interests, whereas the principle of nonmaleficence is (...) tied to the patient’s best medical interests only. The article argues that the principle of nonmaleficence takes priority over the principle of beneficence in that it filters the treatment options that are appropriately subject to the principle of beneficence. Understanding how both principles can play an important role in medical practice, and how they relate when they come into conflict, can help clinicians to avoid certain mistakes in thinking about their duties to their patients. (shrink)

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published in March of 1983 its Report, Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services . Concluding that there are "ethical obligations" on behalf of society which are balanced by individual obligations, the Report provides an ethical framework for ensuring "ultimate responsibility" of the Federal government to arrange for equitable access to health and to a fair (...) share of cost. In doing so the Report neither makes justice nor beneficence the prime moral principle in public health care, it rather calls for a common sense approach in "approximating adequacy". But how to define equality without creating uniformity in a society rich in its diversity, including attitudes towards health? Keywords: justice, beneficence, right to health care, equality, distribution CiteULike Connotea Del.icio.us What's this? (shrink)

Some philosophers claim that there is no morally relevant distinction to be made between duties of rescue and beneficence. In this paper I will highlight an undesirable implication of this position: over-demandingness. After rejecting a prominent attempt to address this problem, I will then advance a virtue-ethical principle that adequately distinguishes the relevant duties and avoids over-demandingness. This principle links wrong actions to character by focusing on the vice of contempt for humanity. Here I will engage with (...) Michael Slote’s similar efforts, critiquing and improving upon them. This essay addresses a gap in the literature on positive duties by appealing to relevant virtue-ethical considerations from within a Neo-Aristotelian framework. (shrink)

This article deals with a discussion of Savulescu’s impersonal version of the Principle of Procreative Beneficence and its relationship with a person-affecting Principle of Harm in order to evaluate the cases of selection of which child to have. It aims to show some problems in Savulescu’s attempt to arrange the two principles (the conflict between beneficence and harm, the limitation of beneficence to pre-conception selection, the extension of beneficence to different quantity people choice), and (...) to propose an alternative version of Procreative Beneficence (a narrow person-affecting version), in order to avoid these problems. (shrink)

Makins’s analysis of the philosophical justification of decision-making understates and so misinterprets the importance of patient values to ‘the deference principle.’ (Makins N,1, p1) He assesses autonomy and beneficence as two separate arguments in support of deferring to patient preferences, but they only work well considered together. Further, neither the constitutive nor the evidential view of beneficence fully recognises the importance of patient values to understanding the patient’s worldview, which in turn determines what risks and benefits matter (...) most. Revising these arguments enables a much fuller understanding of the importance of patient values to the practice of medicine, which will in turn improve the refinement of the deference principle. Autonomy requires beneficence, and vice versa, for either of them to be sufficient arguments for deferring to patient choices. Focusing on autonomy alone to justify deference overstates the value of choice in and of itself, as good medicine does not pursue just any choices. It seeks informed consent, which means that the choices we truly value are those made while understanding what is importantly relevant to the choice. A well-informed decision includes data about expected side effects and likelihood of beneficial effects; but it also includes knowing the patient’s values and goals. One must know what is actually valuable …. (shrink)

If Savulescu's controversial principle of Procreative Beneficence is correct, then an important implication is that couples should employ genetic tests for non-disease traits in selecting which child to bring into existence. Both defenders as well as some critics of this normative entailment of PB have typically accepted the comparatively less controversial claim about non-disease traits: that there are non-disease traits such that testing and selecting for them would in fact contribute to bringing about the child who is expected (...) to have the best life. We challenge this less controversial claim, not by arguing deductively for its falsity, but by showing that Savulescu's central argument for this presumably less controversial claim fails. Savulescu offers intelligence as the paradigm example of a testable non-disease trait such that testing and selecting for it would increase the likelihood that the child selected would be the one who is expected to have the best life. We provide a series of arguments aimed at demonstrating that Savulescu's argument from intelligence fails. If our arguments are successful, the upshot is not that PB is false, but more modestly, that the burden of proof remains squarely with Savulescu. (shrink)

In this paper, I present briefly a view about intrinsic value, one connected to the concepts of ethically required attitudes of favor, disfavor, and preference. If lives can have both welfare value and intrinsic value, how are these values related? I defend the view that the welfare value of a life does not track the intrinsic value of that life. Some philosophers, however, deny that anything can have intrinsic value or absolute value. Some argue that to hold that something is (...) both bad for a person and bad simpliciter leads to an objectionable double counting. Others hold views that would, if true, diminish the practical importance of intrinsic value. Some hold that our relations with others should not be guided by what is intrinsically good or bad, but only by what is good or bad for someone. Others hold that the concepts of love, benefit, and harm are tied exclusively to welfare value or well-being. Still others suggest that the moral principles of beneficence and non-maleficence are tied exclusively to welfare and well-being. I argue that these views are mistaken. In this regard, I attempt to defend the practical importance of intrinsic value. (shrink)

Principles of bcnciiccnce require us to promote the good. If we believe that a plausible mom] conception will contain some such principle, we must address the issue of the demands it imposes on agents. Some writers have defended extremely demanding principles, while others have argued that only principles with limited demands are acceptable. In this paper I su ggest that we 100k at the demands 0f beneficencc in a different way; 0ur concern should not just be with the extent (...) of the demands faced by individual agents. Instead, we should consider how the demands imposed Ol'] an agent by a principle of beneiiccncc are affected by the level of compliance with the principle by others. Act—[email protected], for example, in effect requires each complying agent to shoulder her share of the demands of bcncficcnce plus as many of the shares of noncomplying agents as would be optimal. I suggest that we focus OH this feature ofconsequentialism, and not just on the very high demands it can impose Ol'] individual agents. Thus I defend the View that principles of beneiicence should not demand more of agents as expected compliance by othcr agents decreases, and formulate a principle of bencficcnce that meets this condition. This View about beneiicence and compliance is supported by a particular conception 0f beneiiccnce. Rather than as an aim we each have as individuals, benciicence could be understood as a cooperative project, where each of us aims to promote the good together with others. If s0, it would be natural t.. (shrink)

Why potential parents should select the best child of possible children, and the necessity of a dialogue about the context of a reproductive decision.The principle of Procreative Beneficence is the principle of selecting the best child of the possible children one could have. This principle is elaborated on and defended against a range of objections. In particular, focus is laid on four objections that Michael Parker raises: that it is underdetermining, that it is insensitive to the (...) complex nature of the good, that it is self-defeating and that it is overly individualistic. Procreative Beneficence is a useful principle in reproductive decision-making. It is necessary to be more active in making selection decisions about what kind of child to have.Parker1 raises four objections to the principle of Procreative Beneficence . I will address these in turn. Procreative Beneficence is underdeterminingParker claims that Procreative Beneficence is underdetermining. By “underdetermining”, he means that the principle will not give clear and determinate answers as to which lives are better or best. Parker argues that “ranking possible lives as “better” or “worse” is “highly problematic”.Ranking lives is a very complex matter. Let us distinguish between: the value of a whole life and the value of an individual feature of a life .We should also distinguish between valuation ex ante and ex post . In Procreative Beneficence, I likened genetic testing to playing the wheel of fortune.2 Just because we have a weak chance of winning, does not mean we should not play the game. The only reason not to play a game that …. (shrink)

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

The concept of dignity has occasioned a robust conversation in recent healthcare scholarship. When viewed as a whole, research on dignity in healthcare has engaged each of the four bioethical principles popularized by Beauchamp and Childress, but has paid the least attention to beneficence. In this paper, we look at dignity and beneficence. We focus on the dignity promotion component of a model of dignity derived from a grounded theory study. After describing the study and presenting a précis (...) of the resulting model, we review the principle of beneficence and look at the ways in which the notion of dignity promotion can be used to complement our understanding of this principle. Specifically, we explore what we can learn from dignity promotion about the relational nature of beneficence in healthcare and how dignity promotion can be marshaled to help address the epistemological quandary of soft paternalism. (shrink)

Kant and Sidgwick agree that genuine ethical principles must be sourced in reason rather than divine commands. Yet, despite sharing this secular starting point, both philosophers ultimately conclude that the assumption of God’s existence is necessary for the complete viability of practical reason (including principles of morality) within human beings. This mutual reintroduction of God is especially surprising given that Kant and Sidgwick advocate divergent moral theories. The central claim of this chapter is that, despite their philosophical differences, Kant’s and (...) Sidgwick’s respective appeals to the moral necessity of God have a common cause. Both philosophers perceive a deep human need to believe in cosmic justice (i.e., universal harmony between duty and happiness), and their shared hedonic account of well-being colors their conception of what such justice must involve. After explaining how these ideas give rise to the ostensible moral need for faith, I provide a brief defense of an alternative view based on the Stoic belief that the universe is ultimately just, despite the lack of a reliable connection between moral virtue and hedonic well-being. (shrink)

If Savulescu's (2001, 2009) controversial principle of Procreative Beneficence (PB) is correct, then an important implication is that couples should employ genetic tests for non‐disease traits in selecting which child to bring into existence. Both defenders as well as some critics of this normative entailment of PB have typically accepted the comparatively less controversial claim about non‐disease traits: that there are non‐disease traits such that testing and selecting for them would in fact contribute to bringing about the child (...) who is expected to have the best life. We challenge this less controversial claim, not by arguing deductively for its falsity, but by showing that Savulescu's central argument for this presumably less controversial claim fails. Savulescu offers intelligence as the paradigm example of a testable non‐disease trait such that testing and selecting for it would increase the likelihood that the child selected would be the one who is expected to have the best life (or at least as good a life as the others). We provide a series of arguments aimed at demonstrating that Savulescu's argument from intelligence fails. If our arguments are successful, the upshot is not that PB is false, but more modestly, that the burden of proof remains squarely with Savulescu. (shrink)

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?

A relevant problem in reproductive ethics is the moral evaluation of selection of the possible children that the parents can have. This article discusses one of the main attempts to solve this problem, the principle of Procreative Beneficence proposed by Julian Savulescu to define a strong pro-selection perspective. According to Savulescu, such a principle has an impersonal form and is balanced with a person-affecting principle of harm. The article proposes a new person-affecting interpretation of Procreative (...) class='Hi'>Beneficence, distinguishing it from other pro-selection views and exploring its extension beyond selection to other problems of reproductive ethics. (shrink)